Mobile phone-based screening for anemia in young children in western Kenya

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PROJECT SUMMARY/ABSTRACT Anemia is a common, serious, and neglected global public health problem, affecting over 2 billion people with especially high prevalence among children in low-and middle-income countries (LMICs). Unfortunately, despite the high prevalence and negative health consequences of anemia, few routine screening programs exist in LMICs. There is a critical need to identify an easy-to-implement, low-cost strategy to screen and treat anemia and its causes in LMICs, where > 50% of the population and as many as 75% of children under-5 years of age suffer from anemia. In many LMICs, anemia goes undiagnosed, primarily due to lack of access to accurate and affordable laboratory diagnostics. The most common global causes of anemia (iron deficiency, malaria, sickle cell disease) are relatively easy to diagnose with highly effective treatments. Children with chronic illnesses such as HIV are at an even higher risk of anemia with a significant impact on health outcomes. In most high-income countries, infants are universally screened at birth for sickle cell disease and are routinely screened for anemia at least once in early childhood. This screening and treatment paradigm is highly effective and averts the significant morbidity and early mortality associated with anemia. In LMICs, although >50% of children are anemic, there is no systematic screening and limited capacity to diagnose sickle cell disease, iron deficiency, or other underlying causes of anemia when it is detected. The lack of diagnostic laboratory capacity to measure hemoglobin concentration accurately and affordably is a primary limitation to the systematic identification of anemia. In this study, we will use a smartphone-based, noninvasive method to measure hemoglobin and detect anemia by analyzing photos of the palpebral conjunctiva. This smartphone-based method has been shown to accurately measure hemoglobin in a controlled setting in the US but has not been rigorously evaluated in settings where more severe anemia is common. In this study, we will evaluate the utility and accuracy of this mobile health (mHealth) tool to diagnose anemia among young children in western Kenya. Through the R21 phase, we will (Aim 1) develop a community advisory board to proactively consider acceptability and feasibility of this screening intervention and develop an implementation plan and (Aim 2) evaluate the diagnostic accuracy of this mHealth tool in detecting anemia among Kenyan children who are HIV-exposed and unexposed, within the context of multiple etiologies of anemia. If found to be valid, use of this anemia screening tool will be integrated into the health system, according to the implementation plan developed by the Community Advisory Board. We will measure implementation outcomes of the screening program and prospectively evaluate a disease-specific follow-up and treatment plan to assess the clinical impact of this mHealth-based anemia screening and treatment program for children living in western Kenya. This research has important implications to demonstrate the feasibility of an mHealth anemia screening tool and will address a critical gap towards addressing the neglected global burden of anemia.